Pivot and cluster strategy: a preventive measure against diagnostic errors

Diagnostic errors constitute a substantial portion of preventable medical errors. The accumulation of evidence shows that most errors result from one or more cognitive biases and a variety of debiasing strategies have been introduced. In this article, we introduce a new diagnostic strategy, the pivot and cluster strategy (PCS), encompassing both of the two mental processes in making diagnosis referred to as the intuitive process (System 1) and analytical process (System 2) in one strategy. With PCS, physicians can recall a set of most likely differential diagnoses (System 2) of an initial diagnosis made by the physicians' intuitive process (System 1), thereby enabling physicians to double check their diagnosis with two consecutive diagnostic processes. PCS is expected to reduce cognitive errors and enhance their diagnostic accuracy and validity, thereby realizing better patient outcomes and cost- and time-effective health care management.